Provider Demographics
NPI:1124202726
Name:E FRANKLIN LIVINGSTONE MD PC
Entity type:Organization
Organization Name:E FRANKLIN LIVINGSTONE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:LIVINGSTONE MD PC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-854-0011
Mailing Address - Street 1:3560 ORO GRANDE BLVD # 1000
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7209
Mailing Address - Country:US
Mailing Address - Phone:928-854-0011
Mailing Address - Fax:928-854-0012
Practice Address - Street 1:297 LAKE HAVASU AVE S
Practice Address - Street 2:STE 106
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6526
Practice Address - Country:US
Practice Address - Phone:928-854-0011
Practice Address - Fax:928-854-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31013208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ212162OtherDEPARTMENT OF LABOR
AZA14947OtherUPIN
AZZ74943OtherMEDICARE PROV #
AZ250014204OtherMEDICARE RAILROAD
AZAZ0733210OtherBC/BS OF AZ